New York, NY (September 2, 2004) - More and more people appear to be developing diabetes for the first time following kidney transplant, increasing their risk of transplant complications and death, according to a new report released today in the American Journal of Kidney Diseases, a publication of the National Kidney Foundation.
Moreover, people with pre-existing diabetes appear to benefit more from kidney transplantation when it is offered before they develop kidney failure, suggesting that doctors doctors should provide the option of transplantation operation to diabetics sooner, rather than later.
Diabetes mellitus and chronic kidney disease (CKD) are two of the most urgent health problems in the U.S. today. According to the National Kidney Foundation (NKF), more than 20 million Americans – one i in nine adults – have chronic kidney disease. More than 20 million more are at increased risk for developing kidney disease, and most don't even know it.
Diabetes is reaching almost epidemic dimensions in the United States, with 16 million currently afflicted and almost 29 million Americans projected to be diabetic by the year 2050. As a result, the rate of kidney failure among diabetics has doubled over the last decade, with even steeper trends among minority patients. Now, more than 20 percent of all kidney transplant recipients have diabetes.
As part of the study, more than 60 experts – including physicians, surgeons, nurses and allied health professionals – met to discuss state-of-the-art approaches to treating diabetics with advanced chronic kidney disease. The experts addressed the best techniques for treating diabetic patients before transplant, managing kidney disease in the diabetic, treating diabetes after the transplantation operation, and improving long-term kidney transplant outcomes in the diabetic patient. The conference was supported by an unrestricted educational grant from Novartis Pharmaceuticals.
The work groups found that an increasing number of people appear to be developing diabetes for the first time after kidney transplant. As a result, they suffer as many adverse ill consequences over an eight to ten year period as people who had pre-existing diabetes, largely on account of their increased risk of cardiovascular disease. The experts noted that some people diagnosed with post-transplant diabetes mellitus (PTDM) likely had undetected signs of their condition before the transplant.
The same factors that put people at risk of diabetes before transplant likely increase the risk of diabetes after transplant, the experts noted. These risk factors include a family history of the disease, increased age and obesity. Moreover, some of the drugs that help prevent the body from rejecting the new organ – including corticosteroids and tacrolimus – have been linked to an increased risk of PTDM.
In order to prevent diabetes and manage pre-existing diabetes in kidney transplant patients, the experts recommended that doctors try to modify transplant drugs without increasing the risk of rejection, and encourage their patients to adopt the same techniques that help prevent and manage diabetes in the general population, including losing weight, exercising, and taking drugs to reduce blood pressure and cholesterol.
“The National Kidney Foundation has pioneered the dissemination of evidence based guidelines for the treatment of kidney disease and its complications. The move to identifying gaps in the treatment of conditions that cause kidney disease, such as diabetes, is the next major initiative of the NKF,” said Dr. Brian J. G. Pereira, President of the NKF.
For diabetics with advanced CKD, transplant often represents the best chance for long-term survival, and studies show that diabetics fare better if they receive a kidney transplant before they require dialysis. Indeed, this is the ideal for every patient, because all benefit from transplant before dialysis, but diabetics are more than twice as likely to die while on the waiting list for a new organ, suggesting that they may deserve special consideration.
For a free brochure or more information about the onset of diabetes and chronic kidney disease, contact the National Kidney Foundation at (800) 622-9010 or log on to www.transplantrecipients.org.
The National Kidney Foundation is a major voluntary health organization, which seeks to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability of all organs for transplants.